Provider Demographics
NPI:1295847176
Name:MACDONALD, EDWARD (OD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 E SR 434
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708
Mailing Address - Country:US
Mailing Address - Phone:407-327-5560
Mailing Address - Fax:407-327-7873
Practice Address - Street 1:1122 E SR 434
Practice Address - Street 2:SUITE 1000
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708
Practice Address - Country:US
Practice Address - Phone:407-327-5560
Practice Address - Fax:407-327-7873
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3489152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
K7973OtherMEDICARE GROUP ID
FLV05836Medicare UPIN
U5168AMedicare PIN